Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Nov 25:22:67.
doi: 10.1186/s13049-014-0067-x.

The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis

Magnus Andersson Hagiwara  1 , Anders Bremer  2 , Andreas Claesson  3 , Christer Axelsson  4 , Gabriella Norberg  5 , Johan Herlitz  6   7
Affiliations
Meta-Analysis

The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis

Magnus Andersson Hagiwara et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome.

Methods: Databases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages. The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality.

Results: Median delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes. In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%.

Conclusion: An overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of included and excluded studies.
See this image and copyright information in PMC

References

    1. Terkelsen CJ, Jensen LO, Tilsted HH, Thaysen P, Ravkilde J, Johnsen SP, Trautner S, Andersen HR, Thuesen L, Lassen JF. Primary percutaneous coronary intervention as a national reperfusion strategy in patients with ST-segment elevation myocardial infarction. Circulation. 2011;4:570–576. - PubMed
    1. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 1994;343:311–322. - PubMed
    1. Morrison LJ, Verbeek PR, McDonald AC, Sawadsky BV, Cook DJ. Mortality and prehospital thrombolysis for acute myocardial infarction: A meta-analysis. JAMA. 2000;283:2686–2692. doi: 10.1001/jama.283.20.2686. - DOI - PubMed
    1. Scottish Intercollegiate Guidelines Network: SIGN 50: A guideline developer's handbook [http://www.sign.ac.uk/]
    1. Deeks J, Dinnes J, D’Amico R, Sowden A, Sakarovitch C, Song F, Petticrew M, Altman DG. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7:1–173. doi: 10.3310/hta7270. - DOI - PubMed

MeSH terms